| NPI | 1497396485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP144604) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 739753) |
| 363L00000X Nurse Practitioner (Licence: TX AP144604) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2022-12-30 |