| NPI | 1922648419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347909) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 527947) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2021-08-03 |