NPI | 1689720385 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 794822) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R25438) |
Enumeration Date | 2007-01-26 |
Last Update Date | 2018-07-24 |