| NPI | 1609849215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F334090) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F334090) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NY F334090) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2021-12-06 |