| NPI | 1205227352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F339089) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F339089-1) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2024-05-14 |