NPI | 1871040501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP131945) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP131945) |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP131945) | |
Enumeration Date | 2016-09-11 |
Last Update Date | 2016-09-11 |