| NPI | 1386001485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308914) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: NY 421359) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2019-09-26 |