| NPI | 1033185822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F33169-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY F33169-1) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2015-02-04 |