NPI | 1447825161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX U8436) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: TX U8436) |
Enumeration Date | 2021-05-25 |
Last Update Date | 2024-10-09 |