| NPI | 1457902058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 349573) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11004216) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2022-05-19 |