NPI | 1255879300 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP133157) |
Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP133157) |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP133157) | |
Enumeration Date | 2017-02-09 |
Last Update Date | 2025-04-11 |