NPI | 1629195003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP009214) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN504151L) |
363L00000X Nurse Practitioner (Licence: PA SP009214) | |
Enumeration Date | 2007-03-23 |
Last Update Date | 2017-06-26 |