NPI | 1366435133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 547658) |
Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX 547658) |
Enumeration Date | 2005-08-26 |
Last Update Date | 2009-10-06 |