| NPI | 1184853566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 335923) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY f335923-1) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2026-04-13 |