| NPI | 1629555602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: TX AP132793) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP132793) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2020-03-12 |