NPI | 1740274778 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 619053) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 619053) |
Enumeration Date | 2005-09-06 |
Last Update Date | 2009-08-13 |