NPI | 1861121824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95021194) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95021194) |
Enumeration Date | 2022-06-06 |
Last Update Date | 2022-11-02 |