NPI | 1912548322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN311161) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 873044) |
Enumeration Date | 2019-10-07 |
Last Update Date | 2024-02-14 |