NPI | 1093274607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP140975) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61320029) |
Enumeration Date | 2019-03-14 |
Last Update Date | 2023-11-09 |