NPI | 1528565132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN294524) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 130004) |
363LA2100X Nurse Practitioner, Acute Care (Licence: MT 130004) | |
Enumeration Date | 2018-04-10 |
Last Update Date | 2020-07-20 |