| NPI | 1578178216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1059026) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 740015) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2021-11-18 |