NPI | 1083211726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 69453) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431787) |
Enumeration Date | 2020-10-06 |
Last Update Date | 2023-03-27 |