| NPI | 1528791456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1086577) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 860674) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1086577) | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2023-01-11 |