| NPI | 1891962106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP116577) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 717214) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2022-06-04 |