NPI | 1750160362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7964753-4405) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7964753-8900) |
Enumeration Date | 2023-09-22 |
Last Update Date | 2024-12-10 |