| NPI | 1619221934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP122586) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 740497) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: MI 4704405482) | |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2024-03-25 |