| NPI | 1851890388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 826187) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP136490) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 826187) | |
| Enumeration Date | 2018-02-11 |
| Last Update Date | 2024-10-11 |