| NPI | 1043646284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339361) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 677006) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2018-10-23 |