NPI | 1962455451 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145756) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN11551) |
Enumeration Date | 2006-05-18 |
Last Update Date | 2020-06-11 |