NPI | 1376898965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 114963) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 100637) |
363LA2100X Nurse Practitioner, Acute Care (Licence: GA GAA-NP002701) | |
363LF0000X Nurse Practitioner, Family (Licence: IL 041.372410) | |
Enumeration Date | 2012-07-19 |
Last Update Date | 2024-10-07 |