NPI | 1871357426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1167694) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 9521708-4405) |
Enumeration Date | 2024-02-13 |
Last Update Date | 2024-09-22 |