NPI | 1407936800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 960061) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024167082) |
363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0017138782) | |
Enumeration Date | 2006-10-17 |
Last Update Date | 2021-12-07 |