| NPI | 1619533536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 74291) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP141583) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 207182) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 213690) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP141583) | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2024-03-13 |