NPI | 1962015420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013564) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5013564) |
Enumeration Date | 2020-08-25 |
Last Update Date | 2023-05-22 |