| NPI | 1487122933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 331862) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F343785) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2025-08-06 |