| NPI | 1568132629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP1023722) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AR AP214920) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2021-09-20 |