| NPI | 1841916004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1097802) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 954026) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2023-01-18 |