| NPI | 1730710781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345460) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 716953) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2020-03-13 |