| NPI | 1164825204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311048) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 691305) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2022-12-26 |