NPI | 1104253434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 063188-23) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 063188-23) |
363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101.0118274) | |
Enumeration Date | 2013-10-01 |
Last Update Date | 2022-08-17 |