NPI | 1578856126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F305506) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F450038) |
Enumeration Date | 2011-05-16 |
Last Update Date | 2011-05-16 |