| NPI | 1417046608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 464655) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: TX 464655) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2011-08-02 |