NPI | 1326617598 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1051689) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 353172) |
363LF0000X Nurse Practitioner, Family (Licence: FL 11013826) | |
Enumeration Date | 2021-06-22 |
Last Update Date | 2024-10-22 |