NPI | 1215765698 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5020501) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5020501) |
Enumeration Date | 2024-07-25 |
Last Update Date | 2024-08-05 |