| NPI | 1225110166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172465) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F3345001) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-09-17 |