| NPI | 1730583840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP126076) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP126076) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2022-08-02 |