| NPI | 1104909688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP115175) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP 16852) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2017-01-31 |