NPI | 1902387293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95009361) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 841328) |
363LG0600X Nurse Practitioner, Gerontology (Licence: NV 841328) | |
Enumeration Date | 2018-08-24 |
Last Update Date | 2024-09-04 |