NPI | 1609819747 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP110439) |
Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 594436) |
Enumeration Date | 2006-06-14 |
Last Update Date | 2020-09-11 |