| NPI | 1174325377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F354104-01) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024190410) |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-03-26 |