| NPI | 1831915487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1182259) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: TX 708044) |
| Enumeration Date | 2024-11-27 |
| Last Update Date | 2025-09-15 |