| 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 |