| NPI | 1114647047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1213556) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 903391) |
| 363L00000X Nurse Practitioner (Licence: CA 95023008) | |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2026-05-05 |