| NPI | 1750905139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1140154) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 990121) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-02-16 |