NPI | 1912248899 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306147-1) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340853-1) |
Enumeration Date | 2013-03-03 |
Last Update Date | 2013-03-03 |