| NPI | 1770128464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY F309249-01) |
| Enumeration Date | 2019-11-17 |
| Last Update Date | 2020-05-01 |