| NPI | 1578172904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9421639-4405) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 9421639-3102) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2020-08-28 |