| NPI | 1558060715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1111769) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 967363) |
| 164X00000X Licensed Vocational Nurse (Licence: TX 315375) | |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2023-04-11 |