NPI | 1700039005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 684424) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 684424) |
Enumeration Date | 2008-10-30 |
Last Update Date | 2011-03-30 |