| NPI | 1760920367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1151233) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00468) |
| 163W00000X Registered Nurse (Licence: TX 1151233) | |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2026-05-29 |