| NPI | 1851421937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP114600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP114600) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 646065) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2023-02-23 |