| NPI | 1720776883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 140410334405) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: UT 8406658-3102) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2025-01-08 |