| NPI | 1609143460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP121166) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024188097) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 86651) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 747453) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024188097) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024188097) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2026-01-16 |