| NPI | 1124256367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 305132) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F305132) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2021-10-20 |