NPI | 1316609639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: TX 1056947) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1056947) |
Enumeration Date | 2021-10-13 |
Last Update Date | 2023-06-19 |