| NPI | 1760903199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP135904) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 774783) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP135904) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2024-03-21 |