| NPI | 1831208966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP116895) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 139357) |
| 363L00000X Nurse Practitioner (Licence: TX 761283) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-06-20 |