| NPI | 1336613785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 348868) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 25411) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2022-04-13 |