NPI | 1548768542 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1031936) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1031936) |
Enumeration Date | 2018-01-25 |
Last Update Date | 2024-08-06 |