| NPI | 1932784279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1029709) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX 1029709) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-05-12 |