| NPI | 1023716123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1111165) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1111165) |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-08-23 |