NPI | 1114955754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP113903) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM R45887) |
Enumeration Date | 2006-06-30 |
Last Update Date | 2024-09-19 |