| NPI | 1033882162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY F345437-01) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2021-08-17 |