| NPI | 1720453954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: SC 23337) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP130336) |
| 363L00000X Nurse Practitioner (Licence: AL 1-137158) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: NC 5010304) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2022-07-11 |