| NPI | 1881107225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 346885) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP018058) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2021-01-11 |