| NPI | 1669975892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 6828796-4405) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: UT 6828796-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 6828796-4405) | |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2025-11-26 |