NPI | 1477124253 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70023739) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046658) |
363LF0000X Nurse Practitioner, Family (Licence: AZ 328363) | |
Enumeration Date | 2021-07-02 |
Last Update Date | 2025-10-07 |