| NPI | 1053752899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX ap124212) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 632635) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2021-02-11 |