NPI | 1205477874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144044) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F09191673) |
Enumeration Date | 2019-10-03 |
Last Update Date | 2022-07-15 |