| NPI | 1992553549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1153885) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 850505) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1153885) | |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2024-05-31 |