| NPI | 1235893249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1077858) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 908717) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2022-05-11 |