| NPI | 1932770104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014428) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 347609) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2022-05-09 |