| NPI | 1932695517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179157) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343251) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2020-07-22 |