| NPI | 1538581475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10081544) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 766711) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2022-06-01 |