| NPI | 1134752199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP145632) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP145632) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2022-05-23 |