| NPI | 1457903320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 344242) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 344242) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2023-09-25 |