NPI | 1255009114 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000029981) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 906168) |
363LF0000X Nurse Practitioner, Family (Licence: MS 906168) | |
363LF0000X Nurse Practitioner, Family (Licence: TN APN0000029981) | |
Enumeration Date | 2021-09-03 |
Last Update Date | 2023-10-18 |