| NPI | 1407552078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1111849) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 948740) |
| 163WH0200X Registered Nurse, Home Health (Licence: TX 111849) | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2024-03-04 |