NPI | 1699242842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139763) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 816201) |
363LF0000X Nurse Practitioner, Family (Licence: WA AP60909284) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60909284) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: NV 816201) | |
Enumeration Date | 2018-10-25 |
Last Update Date | 2023-10-13 |