| NPI | 1487188892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 7547) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY F341341-1) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F341341-1) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2019-10-10 |