| NPI | 1942511480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP119069) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95009156) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-11-16 |