NPI | 1376114132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046533) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1046533) |
363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1046533) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1046533) | |
Enumeration Date | 2021-07-02 |
Last Update Date | 2025-07-07 |