NPI | 1174089718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 289574) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP140311) |
363LF0000X Nurse Practitioner, Family (Licence: NM 71452) | |
Enumeration Date | 2019-02-19 |
Last Update Date | 2023-06-07 |