NPI | 1023420809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 30017) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9296521) |
363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-114040) | |
Enumeration Date | 2014-05-28 |
Last Update Date | 2025-05-29 |