NPI | 1669839031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F349130-01) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2016-01-15 |
Last Update Date | 2024-07-10 |