NPI | 1649735143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139812) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 828949) |
Enumeration Date | 2019-02-08 |
Last Update Date | 2024-09-16 |