NPI | 1568132090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1054696) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 00000000000) |
363LA2100X Nurse Practitioner, Acute Care (Licence: NM 65355) | |
363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1054696) | |
363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NM 65355) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1054696) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: NM 65355) | |
Enumeration Date | 2021-09-16 |
Last Update Date | 2021-10-26 |