NPI | 1508591579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3018085) |
Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KY 3018085) |
Enumeration Date | 2022-07-22 |
Last Update Date | 2024-10-14 |