| NPI | 1811394752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1070127) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 116194) |
| 163W00000X Registered Nurse (Licence: TX 850536) | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2024-08-29 |