| NPI | 1457846982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP137029) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 845389) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-05-15 |