| NPI | 1427814995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F353484-01) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030542) |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-02-22 |