NPI | 1013636463 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016803) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5016803) |
Enumeration Date | 2022-08-26 |
Last Update Date | 2022-08-29 |