NPI | 1558046565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 30267) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5018281) |
363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5018281) | |
Enumeration Date | 2023-06-19 |
Last Update Date | 2025-09-15 |