NPI | 1225691736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 235375) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 868612) |
Enumeration Date | 2019-04-19 |
Last Update Date | 2021-12-17 |