NPI | 1023216389 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP116800) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 739810) |
Enumeration Date | 2007-07-10 |
Last Update Date | 2017-05-10 |