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 |