| NPI | 1407470412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345381) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 0888210) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2020-10-21 |