NPI | 1174397194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 15670-33) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WI 164543-30) |
Enumeration Date | 2023-11-09 |
Last Update Date | 2024-11-12 |