NPI | 1992765457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A001486) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 90263) |
363LF0000X Nurse Practitioner, Family (Licence: TX 789876) | |
Enumeration Date | 2006-03-27 |
Last Update Date | 2025-06-12 |