| NPI | 1275014607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F343716-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9401252) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2020-08-14 |