| NPI | 1114308947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 352300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 647364) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2024-03-19 |