NPI | 1073252854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP026008) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA RN584989) |
Enumeration Date | 2022-06-01 |
Last Update Date | 2022-12-20 |