| NPI | 1669099131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 349216) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2329005) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2023-08-13 |