| NPI | 1073941225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F339816-01) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306708-1) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2021-04-24 |