| NPI | 1821010109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP111203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 604645) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 604645) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-11-14 |