NPI | 1972302115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1193829) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 924739) |
Enumeration Date | 2025-03-11 |
Last Update Date | 2025-03-28 |