NPI | 1376106922 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-153480) |
Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: AL 1-153480) |
Enumeration Date | 2019-04-18 |
Last Update Date | 2020-09-21 |