| NPI | 1336101328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP111778) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 582140) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2021-01-11 |