| NPI | 1568424034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 333862) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 333862) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 333862) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2011-09-06 |