NPI | 1962915223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP135773) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 57501) |
Enumeration Date | 2017-11-08 |
Last Update Date | 2019-10-25 |