| NPI | 1275332918 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 0001290486) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001290486) | 
| 363L00000X Nurse Practitioner (Licence: TX 1200930) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1200930) | |
| Enumeration Date | 2025-03-12 | 
| Last Update Date | 2025-06-05 |