NPI | 1679461818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 312441) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 795387) |
Enumeration Date | 2025-06-26 |
Last Update Date | 2025-08-22 |