| NPI | 1962278556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6185751-4405) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 6185751-3102) |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2024-04-01 |