NPI | 1962985606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 85486) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135105) |
Enumeration Date | 2018-09-10 |
Last Update Date | 2025-09-02 |