NPI | 1154893618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 817125) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139981) |
Enumeration Date | 2018-12-21 |
Last Update Date | 2024-10-11 |