| NPI | 1306288444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP124049) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 690658) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2018-10-08 |