NPI | 1063512077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71003826A) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71003826A) |
363L00000X Nurse Practitioner (Licence: KY 42960) | |
363LA2100X Nurse Practitioner, Acute Care (Licence: KY 42960) | |
Enumeration Date | 2006-09-22 |
Last Update Date | 2024-11-05 |