| NPI | 1790357937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1045274) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1045274) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1045274) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1045274) | |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2023-04-03 |