NPI | 1740829027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP144488) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144488) |
Enumeration Date | 2020-01-03 |
Last Update Date | 2022-11-02 |