| NPI | 1881088755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP127262) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP127262) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP127262) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2022-09-20 |