| NPI | 1073169785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309327-01) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 309327-01) |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2019-08-18 |