NPI | 1922470335 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP129185) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 2015009023) |
Enumeration Date | 2015-10-24 |
Last Update Date | 2016-06-09 |