| NPI | 1649038159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 7353740-4405) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: UT 7353740-4405) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: UT 7353740-4405) | |
| 251G00000X Hospice Care, Community Based (Licence: UT 7353740-4405) | |
| 163W00000X Registered Nurse (Licence: UT 7353740-3102) | |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2024-03-08 |