| NPI | 1669206058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1167632) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 80502) |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-28 |