NPI | 1699508234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 2024065540) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 2024065540) |
Enumeration Date | 2024-08-20 |
Last Update Date | 2025-08-06 |