| NPI | 1205158128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 279869-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 279869-4405) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201390022NP-PP) | |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2025-07-18 |