NPI | 1407379043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71007420A) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3011669) |
Enumeration Date | 2017-07-25 |
Last Update Date | 2022-07-21 |