| NPI | 1528365194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F336592) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2282934) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2015-06-03 |