NPI | 1235893249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1077858) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 908717) |
Enumeration Date | 2021-10-26 |
Last Update Date | 2022-05-11 |