| NPI | 1013483361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP139223) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 757993) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2023-06-21 |