NPI | 1801591250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1112741) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1112741) |
363LF0000X Nurse Practitioner, Family (Licence: TX 1112741) | |
Enumeration Date | 2023-04-04 |
Last Update Date | 2023-09-12 |