| NPI | 1023890241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F353006-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY F353006-01) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2023-10-23 |