| NPI | 1932769072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: TX PENDING) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP142860) |
| 363L00000X Nurse Practitioner (Licence: TX AP142860) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2026-06-22 |