NPI | 1588195515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000022262) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN266135) |
363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN266135) | |
363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000022262) | |
Enumeration Date | 2017-03-22 |
Last Update Date | 2023-04-12 |