| NPI | 1427432343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 342473) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 702343) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2023-06-29 |