NPI | 1063992857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H161051) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 6124) |
363LA2100X Nurse Practitioner, Acute Care (Licence: MN 6124) | |
363LA2100X Nurse Practitioner, Acute Care (Licence: MN 2464790) | |
Enumeration Date | 2018-08-21 |
Last Update Date | 2020-10-20 |