| NPI | 1225703036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1047251) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: LA 220881) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2023-04-24 |