| NPI | 1073989026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F307861) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 6795) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2021-01-17 |