| NPI | 1235605064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024180467) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX AP139389) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP139389) | |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2023-10-05 |