| NPI | 1265159032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1101445) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 2022066689) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-02-04 |