NPI | 1457850042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-82296-102) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135611) |
Enumeration Date | 2018-02-08 |
Last Update Date | 2024-03-26 |