NPI | 1922442508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9281426) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F338395) |
Enumeration Date | 2013-04-25 |
Last Update Date | 2024-03-27 |