NPI | 1215762182 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61574871) |
Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA AP61574871) |
363LF0000X Nurse Practitioner, Family (Licence: WA AP61574871) | |
Enumeration Date | 2024-09-03 |
Last Update Date | 2024-11-08 |