| NPI | 1073929154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 568695-1) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F430815-1) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-22 |