| NPI | 1619040367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP111012) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 634743) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2023-03-07 |