NPI | 1518142371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 783952) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 267815) |
Enumeration Date | 2007-12-29 |
Last Update Date | 2024-04-08 |