| NPI | 1619229366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F337563) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 005163) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R232067) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2023-11-21 |