| NPI | 1104570365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1059236) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1059236) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2026-03-16 |