NPI | 1780075473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A004574) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127398) |
Enumeration Date | 2015-02-17 |
Last Update Date | 2024-05-24 |