| NPI | 1023129384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F333048-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME 049985) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-08-19 |