NPI | 1518436252 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP140030) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 801295) |
Enumeration Date | 2018-11-23 |
Last Update Date | 2023-09-12 |