| NPI | 1790220028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP131957) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX AP131957) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP131957) | |
| Enumeration Date | 2016-12-22 |
| Last Update Date | 2022-01-27 |