| NPI | 1063845154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 345573) |
| Additional Taxonomies | 2279C0205X Respiratory Therapist, Registered Critical Care (Licence: NY 008538) |
| 363LF0000X Nurse Practitioner Family (Licence: NY F345573-01) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2022-05-23 |