| NPI | 1134673494 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TX AP131482)  | 
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX AP131482)  | 
| Enumeration Date | 2016-08-04 | 
| Last Update Date | 2016-08-04 |