NPI | 1477541779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 11846) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 005002286) |
363LA2100X Nurse Practitioner, Acute Care (Licence: FL NP3029682) | |
363LF0000X Nurse Practitioner, Family (Licence: NC 149084) | |
Enumeration Date | 2005-10-11 |
Last Update Date | 2025-02-19 |