Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1104443944 |
---|---|
Provider Name | Nelson Lasana Freeman |
First Address | Houston, TX 77082-6634 |
Second Address | Houston, TX 77082-6634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2020 |
Last Update Date | 27/06/2020 |