| NPI | 1750954053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1058845) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 899182) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2022-07-22 |