| NPI | 1679024194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024178204) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP131676/RN 905070) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024178204) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2023-11-27 |