| NPI | 1295068237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F346535-01) |
| Additional Taxonomies | 2279G1100X Respiratory Therapist, Registered, General Care (Licence: NY 006323) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2020-08-28 |