NPI | 1821760117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 348608) |
Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: NY 715785) |
Enumeration Date | 2021-10-04 |
Last Update Date | 2021-11-23 |