| NPI | 1861628505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1102060) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00474) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2023-02-09 |