NPI | 1851590681 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 780890) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 3101372) |
Enumeration Date | 2007-07-12 |
Last Update Date | 2010-09-22 |