| NPI | 1760512586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F337953-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN169872NP) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2024-11-12 |