NPI | 1366889206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP123763) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 750341) |
Enumeration Date | 2013-06-02 |
Last Update Date | 2015-06-30 |