| NPI | 1093111627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F339257-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011804) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2024-03-07 |