NPI | 1285279307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP144979) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 696424) |
363LF0000X Nurse Practitioner, Family (Licence: TX AP144979) | |
Enumeration Date | 2019-11-13 |
Last Update Date | 2022-11-30 |