| NPI | 1740789759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP136606) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 788174) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2022-07-19 |