| NPI | 1770032310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 750844) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP132533) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2026-03-13 |