| NPI | 1881102333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2018000922) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP135400) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |