| NPI | 1467090589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345408) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 724561) |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2020-02-03 |