| NPI | 1639519200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F338013) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 338013) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2017-01-23 |