| NPI | 1407285513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 742585) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 57391) |
| 163W00000X Registered Nurse (Licence: WA RN60022927) | |
| 163W00000X Registered Nurse (Licence: TX 742585) | |
| 363L00000X Nurse Practitioner (Licence: WA AP60317795) | |
| 363L00000X Nurse Practitioner (Licence: TX AP122618) | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2020-10-14 |