| NPI | 1225363450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F336389) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA sp010480) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2011-11-23 |