| NPI | 1225472335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F348471-01) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11004656) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2022-04-28 |