| NPI | 1750651055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP119679) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 733347) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2018-10-01 |