| NPI | 1932904612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1192128) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 957243) |
| 363L00000X Nurse Practitioner (Licence: TX 957243) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 957243) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1192128) | |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-03-21 |