| NPI | 1275335507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 1024600) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1024600) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 14267079-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP70095685) | |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2026-03-12 |