| NPI | 1407624190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 10665000-3102) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 10665000-3102) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 10665000-4405) | |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2024-08-29 |