| NPI | 1861769598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP120223) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 705297) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2024-04-04 |