| NPI | 1487454013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1192683) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX 1192683) |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-06-17 |