| NPI | 1659874709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 351602) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 11418201-4405) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2023-10-19 |