| NPI | 1952060469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 348913) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F348913-01) |
| Enumeration Date | 2021-12-12 |
| Last Update Date | 2022-11-08 |