| NPI | 1952921629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F355368-01) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013473) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-12-08 |