NPI | 1104562701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95029925) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95165644) |
Enumeration Date | 2022-05-07 |
Last Update Date | 2024-05-30 |