| NPI | 1184144289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP134859) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP134859) |
| 363L00000X Nurse Practitioner (Licence: TX AP134859) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2024-12-11 |