| NPI | 1639692965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX AP134553) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 880140) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2025-10-01 |