NPI | 1144518879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4537-33) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 158574-30) |
Enumeration Date | 2011-07-15 |
Last Update Date | 2024-05-02 |