| NPI | 1699449801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1046858) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1046858) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1046858) | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2022-01-03 |