NPI | 1942099502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 15260) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 86136) |
Enumeration Date | 2025-05-01 |
Last Update Date | 2025-08-21 |