NPI | 1619221751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 337990) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 6437901) |
Enumeration Date | 2012-10-27 |
Last Update Date | 2020-02-18 |