| NPI | 1154897502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TX AP139648) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP139648) |
| 163W00000X Registered Nurse (Licence: TX 731092) | |
| 363L00000X Nurse Practitioner (Licence: TX AP139648) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: TX AP139648) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX AP139648) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2023-03-02 |