| NPI | 1972203362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1113743) |
| Additional Taxonomies | 163WP0218X Registered Nurse, Pediatric Oncology (Licence: TX 936274) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1113743) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 1113743) | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-27 |