NPI | 1073243572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 282834) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1082583) |
163W00000X Registered Nurse (Licence: NC 282834) | |
163W00000X Registered Nurse (Licence: TX 1082583) | |
Enumeration Date | 2022-06-16 |
Last Update Date | 2024-09-18 |