NPI | 1467085324 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 10024551) |
Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: MI 4704327371) |
363LF0000X Nurse Practitioner Family (Licence: CA 95027203) | |
Enumeration Date | 2020-02-19 |
Last Update Date | 2024-05-03 |