| NPI | 1932706025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1036057) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: TX 884748) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2023-03-07 |