| NPI | 1750750030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX F0915006) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP129346) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2024-03-04 |