| NPI | 1316437718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F342905) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 738301-1) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2023-03-07 |