| NPI | 1528702776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310711) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 310711) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-07-22 |