| NPI | 1275088031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP131815) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CO 0187139) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2019-01-10 |