NPI | 1497184378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WY 34286.1346) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0990808-NP) |
363LF0000X Nurse Practitioner, Family (Licence: MA RN2259982) | |
Enumeration Date | 2013-11-01 |
Last Update Date | 2018-11-14 |