| NPI | 1447965959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1100750) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 1100750) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-03-03 |