| NPI | 1235368556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 250614) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: TX 250614) |
| 163WW0000X Registered Nurse, Wound Care (Licence: TX 250614) | |
| 364S00000X Clinical Nurse Specialist (Licence: TX 250614) | |
| 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: TX 250614) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2014-07-09 |