| NPI | 1235509571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP129602) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 794504) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2026-04-27 |