NPI | 1346571411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 14736) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 14736) |
363LF0000X Nurse Practitioner, Family (Licence: TN 14736) | |
Enumeration Date | 2010-01-28 |
Last Update Date | 2022-02-02 |