| NPI | 1720879901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1216703) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 945342) |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2026-03-03 |