| NPI | 1922734755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1071782) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 827204) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2024-11-01 |