NPI | 1194340687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 96293) |
Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: WV 96293) |
Enumeration Date | 2020-06-10 |
Last Update Date | 2024-05-21 |