NPI | 1063207900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11038869) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 990887) |
163W00000X Registered Nurse (Licence: FL 9618821) | |
363LF0000X Nurse Practitioner, Family (Licence: NY 357293) | |
Enumeration Date | 2025-04-11 |
Last Update Date | 2025-09-08 |