| NPI | 1568875151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MS R878670) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP136188) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R878670) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2023-12-04 |