| NPI | 1073772794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: NY 420792) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 420792) |
| 207RX0202X Internal Medicine, Medical Oncology (Licence: NY 420792) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2018-09-10 |