| NPI | 1811245640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 337337) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 616031) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2021-04-27 |