| NPI | 1477845519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP120611) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 724396) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2022-08-11 |