NPI | 1801288873 |
---|---|
Former Name | LIJO JOSE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127540) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 754211) |
Enumeration Date | 2015-02-26 |
Last Update Date | 2017-10-24 |