NPI | 1477014132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP141094) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP141094) |
Enumeration Date | 2019-03-26 |
Last Update Date | 2023-12-12 |