NPI | 1437661550 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2019037100) |
Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: MO 2005024763) |
163WE0003X Registered Nurse Emergency (Licence: MO 2005024763) | |
Enumeration Date | 2017-10-30 |
Last Update Date | 2019-10-14 |