| NPI | 1720813124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 14290605-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 14290605-4405) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2026-07-14 |