| NPI | 1992254395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F347682) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 801751) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9406167) | |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2021-06-17 |