| NPI | 1710638069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1111524) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 980964) |
| 363L00000X Nurse Practitioner (Licence: TX 980964) | |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2025-08-31 |