NPI | 1568854966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP127508) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP127508) |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP127508) | |
Enumeration Date | 2015-02-23 |
Last Update Date | 2023-03-28 |