NPI | 1235134776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: MO 2000164066) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 74751) |
Enumeration Date | 2005-06-20 |
Last Update Date | 2018-03-17 |