| NPI | 1881581023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 14230566-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10638227-3102) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 14230566-4405) | |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-08-28 |