| NPI | 1518302546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP122730) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP122730) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2024-04-11 |