NPI | 1376275420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 26633) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H169714) |
Enumeration Date | 2022-06-28 |
Last Update Date | 2023-11-21 |