| NPI | 1649997487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 8894789-4405) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: UT 8894789-4405) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-03-09 |