| NPI | 1720853633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1142029) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1142029) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2025-03-12 |