NPI | 1215471727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP132451) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 771636) |
Enumeration Date | 2016-12-19 |
Last Update Date | 2022-05-10 |