| NPI | 1962814848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9493577) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F338751-1) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2020-12-08 |