NPI | 1588060792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC YORK-0FBA8) |
Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WV 57522) |
Enumeration Date | 2014-11-15 |
Last Update Date | 2023-09-06 |