| NPI | 1427576735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1172151) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1172151) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1172151) | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2024-12-19 |