| NPI | 1568940708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX AP138289) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 881724) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2018-07-31 |