| NPI | 1437457249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139907) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 048005-23) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101-0091635) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2023-02-10 |