NPI | 1356685374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP012526) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP014682) |
Enumeration Date | 2012-11-15 |
Last Update Date | 2024-11-05 |