| NPI | 1891425070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 919306) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1082126) |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2022-06-12 |