| NPI | 1548852478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1033107) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX STUDENT) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2023-03-13 |