NPI | 1841642535 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-81393-121) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2016000962) |
363LF0000X Nurse Practitioner, Family (Licence: MO 2019001965) | |
Enumeration Date | 2016-07-06 |
Last Update Date | 2024-10-29 |