NPI | 1346787736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP145412) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-140150) |
Enumeration Date | 2017-01-24 |
Last Update Date | 2020-06-09 |