NPI | 1215642269 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1110502) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F01230562) |
Enumeration Date | 2023-01-13 |
Last Update Date | 2023-03-02 |