NPI | 1245801885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347863) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 347863) |
Enumeration Date | 2021-07-06 |
Last Update Date | 2023-07-07 |