| NPI | 1700915386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F333353) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 333353) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-06-29 |