| NPI | 1811363286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP128757) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 680853) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2024-05-22 |