| NPI | 1285308197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1049201) |
| Additional Taxonomies | 347D00000X Train (Licence: TX 1049201) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2024-07-27 |