| NPI | 1063018935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1020099) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 1020099) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2024-10-02 |