| NPI | 1194292888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1099035) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 870204) |
| 363L00000X Nurse Practitioner (Licence: TX 1099035) | |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2023-02-09 |