NPI | 1265046932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144510) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP144510) |
Enumeration Date | 2020-09-01 |
Last Update Date | 2021-11-11 |