| NPI | 1699894378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP119124) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00623) |
| 363L00000X Nurse Practitioner (Licence: TX F0510035) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2024-10-26 |