NPI | 1720677420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1020160) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 10201299) |
Enumeration Date | 2021-01-16 |
Last Update Date | 2021-03-08 |