| NPI | 1083275630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 70622) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 9037845-8900) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP141978) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2022-12-05 |