| NPI | 1649876111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1020741) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1020741) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2025-01-03 |