| NPI | 1922642941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345218) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 345218) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: NY 345218) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 345218) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 345218) | |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2019-11-01 |