| NPI | 1487705703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 330871) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F330871-1) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-11-24 |