| NPI | 1427501626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F340828-1) |
| Additional Taxonomies | 261QX0200X Clinic/Center, Oncology (Licence: NY F340828-1) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-10-03 |