NPI | 1215600960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347990) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
163W00000X Registered Nurse (Licence: NY 695528) | |
Enumeration Date | 2021-07-28 |
Last Update Date | 2021-08-06 |