| NPI | 1073243572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5020842) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 282834) |
| 363L00000X Nurse Practitioner (Licence: TX 1082583) | |
| 163W00000X Registered Nurse (Licence: TX 1082583) | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2025-11-24 |