| NPI | 1750079349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1116203) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1116203) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1116203) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-08-06 |