NPI | 1902220593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9437549) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC RN1023062) |
Enumeration Date | 2014-02-18 |
Last Update Date | 2016-11-08 |