| NPI | 1962416990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 658215) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 658215) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 658215) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 658215) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 658215) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-02-14 |