NPI | 1669857082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP129030) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 814306) |
363LF0000X Nurse Practitioner, Family (Licence: TX AP129030) | |
Enumeration Date | 2015-07-27 |
Last Update Date | 2023-04-18 |