NPI | 1104327998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135352) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10987) |
Enumeration Date | 2018-02-27 |
Last Update Date | 2024-05-20 |