| NPI | 1215504063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 68552) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 68552) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: ID 68552) | |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 68552) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 68552) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: ID 68552) | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-06-09 |