| NPI | 1326044306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 636828) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 636828) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2007-07-08 |