| NPI | 1902069040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP132757) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1902069040) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1902069040) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2026-04-21 |