| NPI | 1740344415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP107844) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 587893) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 587893) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 587893) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-12-02 |