| NPI | 1629752845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1126560) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1126560) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1126560) | |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2023-08-22 |