| NPI | 1760416663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP112512) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP112512) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-07-21 |