| NPI | 1114612934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F351015) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 2204102) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-09-26 |