NPI | 1417957523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F330581) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F300265) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F360048) | |
363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: NY F380329) | |
Enumeration Date | 2005-07-29 |
Last Update Date | 2010-07-08 |