| NPI | 1528803988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F355013) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 11033270) |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-09-12 |