NPI | 1699223149 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP131861) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131861) |
Enumeration Date | 2016-09-13 |
Last Update Date | 2023-05-01 |