| NPI | 1922770809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1073110) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: TX 824574) |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: TX 1073110) | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2024-02-26 |