| NPI | 1578106803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 354068) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 778961) |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2024-05-22 |