| NPI | 1659753317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP143347) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: TX 727663) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2026-05-08 |