| NPI | 1336770718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 309224) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309224) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2023-02-07 |