| NPI | 1952799686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339692) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013867) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2022-06-29 |