| NPI | 1922035765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP112695) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 658745) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 658745) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2016-04-20 |