NPI | 1093551020 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 354858) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 787797) |
Enumeration Date | 2024-07-09 |
Last Update Date | 2024-10-23 |