| NPI | 1609537430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1242863) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR 218609) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2026-07-15 |