| NPI | 1417538935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 978130) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11038381) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2025-04-22 |