NPI | 1528803988 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F355013) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11033270) |
Enumeration Date | 2024-06-27 |
Last Update Date | 2024-09-12 |