NPI | 1235770942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR 122297) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP143904) |
363LG0600X Nurse Practitioner, Gerontology (Licence: AR 122297) | |
364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX AP143904) | |
Enumeration Date | 2019-10-03 |
Last Update Date | 2024-09-13 |