| NPI | 1689418378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1157185) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1157185) |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2025-10-29 |