| NPI | 1437738986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F34733301) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY f347333-01) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2021-04-02 |