NPI | 1790072551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: HI APRN-1940) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 279971) |
Enumeration Date | 2011-06-30 |
Last Update Date | 2016-03-08 |