| NPI | 1972159952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 8307619-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 8307619-4405) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: UT 8307619-4405) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2026-02-17 |