NPI | 1639895691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 33688) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000244964) |
Enumeration Date | 2022-10-12 |
Last Update Date | 2023-04-05 |