| NPI | 1083944185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 713739) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 713739) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 713739) | |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2022-09-12 |