| NPI | 1568078079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1013975) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1013975) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1013975) | |
| Enumeration Date | 2020-09-20 |
| Last Update Date | 2022-05-05 |