| NPI | 1811456247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX API42166) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: TX 926072) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2019-09-05 |