NPI | 1922552447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307784) |
Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 628243) |
Enumeration Date | 2016-08-12 |
Last Update Date | 2016-08-12 |