| NPI | 1144283664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP113748) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 684692) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP113748) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2021-11-12 |