| NPI | 1417545062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1018950) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1018950) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1018950) | |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2024-10-15 |