| NPI | 1457996241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: NY 344689) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 344689) |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2020-12-18 |