| NPI | 1811547896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F309217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY F309217) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2022-10-14 |