| NPI | 1437627502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 343772) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F343772) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2024-11-20 |