NPI | 1053185942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704363196) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704363196NSA230UV) |
Enumeration Date | 2023-11-10 |
Last Update Date | 2025-02-14 |