| NPI | 1922641299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 73051) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP143635) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP143635) | |
| Enumeration Date | 2019-10-19 |
| Last Update Date | 2023-04-21 |