| NPI | 1598416927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 349091) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NY 349091) |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-01-18 |