| NPI | 1639598485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 755675) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F02210008) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2021-03-17 |