| NPI | 1346968344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP1101061) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 722303) |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2022-12-13 |