| NPI | 1508264904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 338434) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F338434-1) |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2022-07-21 |