| NPI | 1235770942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AR 122297) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX AP143904) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP143904) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AR 122297) | |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2026-02-23 |