NPI | 1750996534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP1028619) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 792196) |
Enumeration Date | 2020-09-09 |
Last Update Date | 2021-02-25 |