NPI | 1588656649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP108928) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 653791) |
Enumeration Date | 2005-08-16 |
Last Update Date | 2021-07-02 |