NPI | 1023332848 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11016567) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 595740) |
363LA2200X Nurse Practitioner, Adult Health (Licence: NY F308343) | |
Enumeration Date | 2010-03-23 |
Last Update Date | 2023-07-10 |