NPI | 1174384721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1130881) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1130881) |
Enumeration Date | 2024-01-22 |
Last Update Date | 2024-01-22 |