| NPI | 1609947258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F304346) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F304346) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-11-13 |