NPI | 1235755521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1029905) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179531) |
Enumeration Date | 2020-06-22 |
Last Update Date | 2022-04-29 |