| NPI | 1619869922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1214593) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 780990) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-11-19 |