| NPI | 1457565269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306828) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F306828) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-03-19 |