| NPI | 1750913695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 69454) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP145223) |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2024-06-14 |