| NPI | 1003261512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP130775) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 754742) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-05-03 |