| NPI | 1679108104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1030570) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 820404) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1030570) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1030570) | |
| 163W00000X Registered Nurse (Licence: TX 820404) | |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2023-02-15 |