| NPI | 1649680554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024190981) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 689063) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP125025) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2024-08-28 |