NPI | 1538718069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA 248546) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 248546) |
163WE0003X Registered Nurse, Emergency (Licence: NY 776334) | |
Enumeration Date | 2019-09-07 |
Last Update Date | 2024-03-29 |