| NPI | 1407482011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP145508) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1407482011) |
| Enumeration Date | 2020-03-15 |
| Last Update Date | 2023-12-09 |