| NPI | 1700806619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9196116) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 322401) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-05-15 |