| NPI | 1851100465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10439551-4405) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: UT 10439551-3102) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-07-10 |