| NPI | 1467099820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TX AP144250) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: TX AP144250) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP144250) | |
| 363LW0102X Nurse Practitioner Women's Health (Licence: TX AP144250) | |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2020-07-07 |