| NPI | 1043517717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: NM 53674) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NY F320081) |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2020-01-13 |