| NPI | 1124502810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 343512) |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology (Licence: NY 343512) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2023-03-22 |