| NPI | 1649266800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F332697) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F332697) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NY F-332697) | |
| 363L00000X Nurse Practitioner (Licence: NY F322697) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2010-11-09 |