| NPI | 1144636713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 306951) |
| Additional Taxonomies | 163WD0400X Registered Nurse Diabetes Educator (Licence: NY 494181) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2019-09-11 |