| NPI | 1306317284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP139499) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP139499) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP139499) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2019-01-07 |