NPI | 1568424034 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 333862) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 333862) |
363LP2300X Nurse Practitioner, Primary Care (Licence: NY 333862) | |
Enumeration Date | 2006-04-03 |
Last Update Date | 2011-09-06 |