| NPI | 1316609639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1056947) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TX 1056947) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2025-10-22 |