| NPI | 1932547569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 306477) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 306477) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2023-03-21 |