| NPI | 1295182962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311498) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R218298) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-03-18 |