| NPI | 1760848667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1034787) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 163W00000X Registered Nurse (Licence: TX 1034787) | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2023-09-18 |