| NPI | 1396123451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 2014022488) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: TX AP127470) |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2025-06-12 |