| NPI | 1487374773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1210331) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95021731) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2025-12-03 |