| NPI | 1528526332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F308844-1) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308844-01) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2022-07-22 |