| NPI | 1083871412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355744) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC 10000713) |
| 1744R1102X Specialist, Research Study (Licence: cert05836) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2025-01-17 |