| NPI | 1356775183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP125784) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 5392-33) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2024-03-07 |