| NPI | 1538162045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 605190) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP108606) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2023-07-03 |