NPI | 1396850871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 630161) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 630161) |
Enumeration Date | 2006-08-21 |
Last Update Date | 2020-02-24 |