| NPI | 1093293185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 343331) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: NY 686891) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |