| NPI | 1902371255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1112656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 944005) |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2023-03-09 |