| NPI | 1972223980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1088397) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1088397) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-09-04 |