| NPI | 1528077369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP11810) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 0370815-28) |
| 163W00000X Registered Nurse (Licence: TX 626529) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2018-10-04 |