| NPI | 1053298216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 512663) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: TX 512663) |
| Enumeration Date | 2025-08-19 |
| Last Update Date | 2025-08-19 |