| NPI | 1265283642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1172155) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 831820) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2026-03-20 |