NPI | 1063741205 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95000338) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R188868) |
Enumeration Date | 2009-12-17 |
Last Update Date | 2022-02-14 |