NPI | 1811491293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND 202660) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP137074) |
Enumeration Date | 2018-03-21 |
Last Update Date | 2025-08-15 |