| NPI | 1922419308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP124995) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP124995) |
| 363L00000X Nurse Practitioner (Licence: TX AP124995) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP124995) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-06-02 |