| NPI | 1386119188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345890) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 24889) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2020-07-20 |