| NPI | 1376917856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6300905-4405) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 6300905-4405) |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: UT 6300905-4405) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9617503) | |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2024-06-26 |