| NPI | 1710607080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350240) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F350240-01) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-11-23 |