| NPI | 1184900300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345166) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 618967) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2022-09-22 |