| NPI | 1962169755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 927885) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 731237) |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2026-05-27 |