NPI | 1902254238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 340771) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 635681) |
Enumeration Date | 2016-05-26 |
Last Update Date | 2016-08-03 |