| NPI | 1205485638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F309521) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11003863) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2020-10-24 |