NPI | 1194234047 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP09406) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP09406) |
363LG0600X Nurse Practitioner, Gerontology (Licence: LA AP09406) | |
Enumeration Date | 2017-09-22 |
Last Update Date | 2024-03-22 |