NPI | 1992496103 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1117837) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11026419) |
Enumeration Date | 2023-05-18 |
Last Update Date | 2023-06-16 |