NPI | 1316162662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95001902) |
Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F430331-1) |
Enumeration Date | 2007-04-13 |
Last Update Date | 2021-01-25 |