| NPI | 1841402831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP113908) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201350013NP) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201350014NP) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2015-06-03 |