| NPI | 1891955043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 609517) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP116883) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2023-11-22 |