NPI | 1790236727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F349976) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 716515) |
Enumeration Date | 2016-10-14 |
Last Update Date | 2025-04-11 |