| NPI | 1932635331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP133902) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP133902) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP133902) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-07-20 |