| NPI | 1750254942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1212476) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1212476) |
| 163WH0200X Registered Nurse, Home Health (Licence: TX 1212476) | |
| 163WW0000X Registered Nurse, Wound Care (Licence: TX 1212476) | |
| Enumeration Date | 2025-09-25 |
| Last Update Date | 2025-09-25 |