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 |