| NPI | 1336418490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TX 1058536) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1058536) |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2023-10-19 |