NPI | 1326393075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9360397) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC006535) |
363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9360397) | |
363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02002) | |
Enumeration Date | 2012-07-18 |
Last Update Date | 2024-05-10 |