NPI | 1831802438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3018133) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71014878A) |
363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3018133) | |
Enumeration Date | 2022-12-29 |
Last Update Date | 2024-04-04 |