| NPI | 1780748277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP112045) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 616672) |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX 616672) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-05-26 |