| NPI | 1770993818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP126442) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 863763) |
| 363L00000X Nurse Practitioner (Licence: MA RN2284744) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2024-05-30 |