| NPI | 1518599240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP145158) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: TX 815253) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2020-02-13 |