| NPI | 1356726848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350208) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9365510) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5017582) | |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2023-04-03 |