| NPI | 1376244988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028584) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 784248) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1110547) | |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2024-05-06 |