NPI | 1205468642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11031606) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 574711-1) |
Enumeration Date | 2020-02-04 |
Last Update Date | 2024-07-18 |