| NPI | 1134695505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP138398) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138398) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2022-09-08 |