| NPI | 1447926779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1182427) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1182427) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1182427) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2026-04-28 |