| NPI | 1063805893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F307616-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 686932-1) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2016-09-06 |