| NPI | 1295011641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse Emergency (Licence: TX 699234) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 699234) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2023-09-23 |