| NPI | 1518459825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 382959) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9429635) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2019-05-05 |