| NPI | 1417599135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024193066) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP144126) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP144126) | |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2025-08-08 |