NPI | 1033480520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121125) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 698372) |
Enumeration Date | 2012-01-16 |
Last Update Date | 2014-11-21 |