NPI | 1992592760 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1029473) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 83753) |
Enumeration Date | 2025-04-23 |
Last Update Date | 2025-06-11 |