| NPI | 1760199467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1112870) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: TX 867716) |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2023-07-10 |