NPI | 1326925090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL APRN11033649) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1046941) |
207Q00000X Family Medicine (Licence: KY 4045371) | |
Enumeration Date | 2025-08-16 |
Last Update Date | 2025-08-16 |