| NPI | 1467074302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP145468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 672090) |
| 363L00000X Nurse Practitioner (Licence: TX AP145468) | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2026-01-08 |