| NPI | 1376850065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: NY F420992) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 340912) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2025-01-29 |