| NPI | 1740694454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP125858) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 709205) |
| 163WE0003X Registered Nurse Emergency (Licence: TX 766200) | |
| 363LF0000X Nurse Practitioner Family (Licence: WI 6653-33) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2016-09-27 |