| NPI | 1407252075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345386) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 624692) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2022-11-29 |