NPI | 1528664182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1032521) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 863346) |
Enumeration Date | 2020-12-09 |
Last Update Date | 2025-07-02 |