| NPI | 1316934573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 301909) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 421621) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-07-21 |