NPI | 1588299077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145338) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP145338) |
Enumeration Date | 2020-03-05 |
Last Update Date | 2021-06-15 |