NPI | 1063985521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024176978) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5011226) |
363LA2100X Nurse Practitioner, Acute Care (Licence: OH CNP.026029) | |
Enumeration Date | 2019-01-08 |
Last Update Date | 2023-10-24 |