| NPI | 1336832971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 352633) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 116304) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2023-09-14 |