| NPI | 1699457960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1132556) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 930566) |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2023-09-25 |