| NPI | 1386030146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP08210) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP126886) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2015-12-17 |