| NPI | 1851464853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F303815) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 303815) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2024-06-04 |