NPI | 1528511409 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 340434) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CT 6545) |
Enumeration Date | 2016-07-27 |
Last Update Date | 2024-07-22 |