Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP131819 | TX |
NPI | 1003367970 |
---|---|
Provider Name | Joseph Sande |
First Address | Katy, TX 77494-3025 |
Second Address | Houston, TX 77070-1148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2016 |
Last Update Date | 17/10/2016 |