| NPI | 1396386348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1071126) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV 825950) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 825950) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-08-28 |