NPI | 1255539821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP132602) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 17346) |
363LF0000X Nurse Practitioner, Family (Licence: IA A150308) | |
Enumeration Date | 2007-07-05 |
Last Update Date | 2018-05-10 |