| NPI | 1124782339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1056311) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1056311) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2021-11-11 |