| NPI | 1669913216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD AC007838) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5009362) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP143693) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5009362) | |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2025-07-17 |