NPI | 1558101964 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2380433) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F354034-01) |
Enumeration Date | 2024-05-31 |
Last Update Date | 2024-09-09 |