| NPI | 1548465354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F335010-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 335010) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2023-07-06 |