NPI | 1336419993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3007284) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 26846) |
Enumeration Date | 2012-01-12 |
Last Update Date | 2022-09-22 |