| NPI | 1669975892 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6828796-4405) | 
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: UT 6828796-4405) | 
| Enumeration Date | 2018-03-14 | 
| Last Update Date | 2025-07-10 |