| NPI | 1972302115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1193829) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1193829) |
| 163W00000X Registered Nurse (Licence: TX 924739) | |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2026-04-13 |