| NPI | 1215170527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP124392) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP124392) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2024-10-14 |