| NPI | 1003697772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD 349665) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 349665) |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2023-10-10 |