NPI | 1003292699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP015186) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015186) |
Enumeration Date | 2015-08-05 |
Last Update Date | 2021-04-13 |