| NPI | 1407351323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP145017) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 821865) |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2023-01-02 |