| NPI | 1669158622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1127807) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 924543) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-08-04 |