| NPI | 1205591294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 1112079) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1112079) |
| 163WA2000X Registered Nurse, Administrator (Licence: TX 913790) | |
| 163W00000X Registered Nurse (Licence: TX 913790) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2024-01-10 |