NPI | 1679356554 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1120099) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1120099) |
Enumeration Date | 2023-08-15 |
Last Update Date | 2023-09-06 |