| NPI | 1659371375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP111360) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 600761) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2022-09-21 |