| NPI | 1760911903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1136499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 989203) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 15-517) | |
| Enumeration Date | 2017-06-10 |
| Last Update Date | 2024-10-02 |