NPI | 1669800546 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP124663) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP124663) |
363LF0000X Nurse Practitioner, Family (Licence: TX 809797) | |
Enumeration Date | 2013-10-31 |
Last Update Date | 2024-09-17 |