| NPI | 1679040919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 353107) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 742300) |
| 170100000X Medical Genetics, Ph.D. Medical Genetics (Licence: NY 353107) | |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-01-16 |