NPI | 1700063278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: TX AP121818) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP04809) |
363LX0106X Nurse Practitioner, Occupational Health (Licence: LA AP04809) | |
Enumeration Date | 2008-01-28 |
Last Update Date | 2025-03-31 |