| NPI | 1013056704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP127093) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 713162) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2014-12-20 |