NPI | 1831661388 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP138976) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138976) |
Enumeration Date | 2018-12-21 |
Last Update Date | 2019-01-03 |