NPI | 1720225949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 204378) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 204378) |
Enumeration Date | 2009-01-09 |
Last Update Date | 2021-04-14 |