NPI | 1245022912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1170193) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 920983) |
Enumeration Date | 2025-05-20 |
Last Update Date | 2025-09-15 |