| NPI | 1629303946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP118278) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 620360) |
| Enumeration Date | 2009-10-04 |
| Last Update Date | 2020-01-28 |