| NPI | 1073150314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 677143) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F345227) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2019-12-05 |