| NPI | 1194174037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 341560) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 701740) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2017-02-27 |