| NPI | 1700316536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1112061) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 902013) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP09299) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2025-08-15 |