| NPI | 1740688530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP126400) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: TX AP126400) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2014-12-15 |