| NPI | 1922402932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP126143) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: TX AP126143) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: TX AP126143) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2022-01-31 |