| NPI | 1528511409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 340434) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 6545) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2024-07-22 |