| NPI | 1144769365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP133936) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 800129) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP133936) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2021-01-08 |