NPI | 1952119943 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355500) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95026580) |
363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15199000) | |
Enumeration Date | 2024-12-21 |
Last Update Date | 2025-03-10 |