| NPI | 1083857270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NY 305118) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: NY 305118) |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: NY 305118) | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2015-02-10 |