| NPI | 1710315106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 66107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 66107) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX 124545) | |
| 363L00000X Nurse Practitioner (Licence: TX 680959) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 680959) | |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2023-09-07 |