| NPI | 1902948086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F332209-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC005113) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015101) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-07-18 |