| NPI | 1629602081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F344523) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NY F344523) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F344523) | |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2024-11-14 |