NPI | 1356069769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN319054) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432397) |
Enumeration Date | 2022-08-22 |
Last Update Date | 2024-07-17 |