| NPI | 1871343152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1174586) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: TX 901501) |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2025-01-24 |