NPI | 1619425410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341571) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00712300) |
363L00000X Nurse Practitioner (Licence: CT 9226) | |
363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00712300) | |
Enumeration Date | 2016-09-21 |
Last Update Date | 2024-11-08 |