| NPI | 1124712260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1121558) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1121558) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-07-06 |