NPI | 1104815836 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 341666) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VT 101-0136760) |
Enumeration Date | 2005-10-15 |
Last Update Date | 2023-12-28 |