| NPI | 1144623356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP126578) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AR 219529) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP126578) | |
| 363LF0000X Nurse Practitioner Family (Licence: AR 219529) | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2023-03-15 |