NPI | 1912476102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139184) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 54500) |
Enumeration Date | 2018-11-16 |
Last Update Date | 2018-11-16 |