| NPI | 1760081962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP69133) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 96119) |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2024-04-26 |