| NPI | 1750711172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP125105) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 717836) |
| 363L00000X Nurse Practitioner (Licence: TX AP125105) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP125105) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 717836) | |
| 363L00000X Nurse Practitioner (Licence: TX 717836) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2025-10-14 |