NPI | 1861383820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 357491) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61576608) |
163W00000X Registered Nurse (Licence: NY 962375) | |
163W00000X Registered Nurse (Licence: CT 211405) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2025-07-09 |
Last Update Date | 2025-09-17 |