| NPI | 1669771887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1116828) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1116828) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2025-02-27 |