| NPI | 1760890578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F337635-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F337635) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2024-02-21 |