| NPI | 1861192346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1112932) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 835430) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-04-04 |