NPI | 1225703036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1047251) |
Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: LA 220881) |
Enumeration Date | 2021-08-12 |
Last Update Date | 2023-04-24 |