| NPI | 1902445497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1105842) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 979158) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2023-01-12 |