| NPI | 1639824485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1061488) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1061488) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1061488) | |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-09-29 |