NPI | 1154919637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1025742) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1025742) |
Enumeration Date | 2021-01-09 |
Last Update Date | 2025-05-07 |