NPI | 1346917689 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1058112) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX F08210556) |
Enumeration Date | 2021-08-25 |
Last Update Date | 2023-02-07 |