| NPI | 1083189864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP139324) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 830503) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2019-03-04 |