| NPI | 1154760080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP122888) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 755573) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2023-08-01 |