NPI | 1528791456 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1086577) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 860674) |
363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1086577) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1086577) | |
363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1086577) | |
Enumeration Date | 2022-07-07 |
Last Update Date | 2025-07-23 |