| NPI | 1639613037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP132718) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP132718) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP132718) | |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2022-06-28 |