| NPI | 1568132090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1054696) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 00000000000) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 65355) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1054696) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NM 65355) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1054696) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NM 65355) | |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2021-10-26 |