| NPI | 1790316305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 345347) |
| Enumeration Date | 2020-02-01 |
| Last Update Date | 2022-05-02 |