NPI | 1982957924 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R235680) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R235680) |
363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010909) | |
363L00000X Nurse Practitioner (Licence: DE LP-0010909) | |
Enumeration Date | 2012-10-15 |
Last Update Date | 2025-09-15 |