| NPI | 1568864031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F34922701) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 1043889967) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: CT 1992372403) | |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 1992372403) | |
| 363L00000X Nurse Practitioner (Licence: CA NP95019560) | |
| 363L00000X Nurse Practitioner (Licence: CT 10399) | |
| 363L00000X Nurse Practitioner (Licence: NJ 26NJ01300300) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP126436) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0003297-C-NP) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2023-02-07 |