NPI | 1548686231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 746329) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125286) |
Enumeration Date | 2014-03-05 |
Last Update Date | 2024-09-17 |