| NPI | 1134818701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10836605-4405) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 10836605-3102) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-26 |