| NPI | 1043749278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY f-342249-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 656075) |
| Enumeration Date | 2017-06-10 |
| Last Update Date | 2020-09-23 |