| NPI | 1932086386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1195224) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1195224) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1195224) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1195224) | |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-11-17 |