NPI | 1669228078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5020665) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 259225) |
Enumeration Date | 2024-04-26 |
Last Update Date | 2024-09-20 |