NPI | 1427727494 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1055634) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F09210496) |
Enumeration Date | 2021-09-12 |
Last Update Date | 2022-01-25 |