| NPI | 1356403075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP135257) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 653891) |
| 363L00000X Nurse Practitioner (Licence: TX AP135257) | |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2023-08-18 |