| NPI | 1396040903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: TX PA07194) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX PA07194) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: TX PA07194) | |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2012-04-24 |