| NPI | 1629800230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1173949) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2025-01-13 |