| NPI | 1760933139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP118667) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 697320) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2017-03-10 |