NPI | 1124380308 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F405095-1) |
Additional Taxonomies | 174400000X Specialist (Licence: NY 891809) |
Enumeration Date | 2012-06-13 |
Last Update Date | 2023-10-25 |