| NPI | 1902336324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 342582) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 653899) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-05-12 |