NPI | 1366915613 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139532) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP139532) |
Enumeration Date | 2019-01-09 |
Last Update Date | 2024-06-19 |