NPI | 1245418706 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 335423) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 475837) |
Enumeration Date | 2008-02-07 |
Last Update Date | 2024-06-25 |