| NPI | 1851367569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F332529) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY F332529) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2018-05-23 |