NPI | 1790039188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 16902) |
Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TN APN0000016902) |
Enumeration Date | 2012-11-07 |
Last Update Date | 2022-07-21 |