| NPI | 1952664641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 337429) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 591686) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 337429) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-02-21 |