NPI | 1013626365 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP11024290) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 350583) |
Enumeration Date | 2022-11-15 |
Last Update Date | 2024-06-18 |