| NPI | 1366869513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 578144) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 578144) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2022-09-26 |