| NPI | 1154513927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 304704) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 530462-1) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |