NPI | 1215467980 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP134493) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 841615) |
Enumeration Date | 2017-06-15 |
Last Update Date | 2023-02-28 |