| NPI | 1720593999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 342344) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 342344) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2023-06-30 |