NPI | 1518449644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP019818) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP019818) |
363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP019818) | |
Enumeration Date | 2018-09-05 |
Last Update Date | 2019-02-12 |