| NPI | 1639851678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NY 352008) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 325008) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 325008) | |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2023-09-25 |