| NPI | 1972894426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345072) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 640880) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2019-12-13 |