NPI | 1336506187 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130102) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP130102) |
Enumeration Date | 2016-01-25 |
Last Update Date | 2025-09-13 |