Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1003128 | TX |
NPI | 1023615143 |
---|---|
Provider Name | Mrs. Aji Sam |
First Address | Houston, TX 77030-4211 |
Second Address | Houston, TX 77030-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2020 |
Last Update Date | 01/10/2020 |