| NPI | 1700547767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1014683) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432058) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1014683) | |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-03-28 |