| NPI | 1972115152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1031030) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: TX 631950) |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: TX 631950) | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2022-05-14 |