| NPI | 1730764325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1028769) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX 1028769) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2026-03-24 |