| NPI | 1275108755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1000151) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TX 1000151) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-10-12 |