| NPI | 1619579505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1066670) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F431810) |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2023-03-30 |