| NPI | 1790560068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1133355) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1133355) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: TX 1133355) | |
| 363LC1500X Nurse Practitioner Community Health (Licence: TX 1133355) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX 1133355) | |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2023-08-25 |