| NPI | 1639466030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1151694) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 863813) |
| 164X00000X Licensed Vocational Nurse (Licence: TX 214866) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-02-02 |