| NPI | 1346611829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP128339) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TX AP128339) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2025-05-20 |