NPI | 1033730080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP142324) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP142324) |
Enumeration Date | 2020-04-30 |
Last Update Date | 2021-09-13 |