NPI | 1134174329 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP108525) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A001314) |
Enumeration Date | 2006-05-24 |
Last Update Date | 2018-08-30 |