NPI | 1790443521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310467) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 310467) |
363LP2300X Nurse Practitioner, Primary Care (Licence: NY 310467) | |
Enumeration Date | 2021-11-29 |
Last Update Date | 2022-02-11 |