| NPI | 1033954797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 354564) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 354564) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2024-09-09 |