| NPI | 1528457827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1022089) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 352952) |
| 163WA2000X Registered Nurse, Administrator (Licence: TX 1022089) | |
| 163WG0000X Registered Nurse, General Practice (Licence: NY 787482) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 30492) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| Enumeration Date | 2015-01-10 |
| Last Update Date | 2026-02-08 |