NPI | 1194526152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1182017) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1182017) |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1182017) | |
Enumeration Date | 2025-03-24 |
Last Update Date | 2025-03-24 |