NPI | 1710288535 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F305496-1) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 555729-1) |
Enumeration Date | 2010-11-10 |
Last Update Date | 2013-05-13 |