| NPI | 1497825459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 05969) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP113276) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2026-06-04 |