| NPI | 1841906005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1110869) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 934497) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-02-17 |