| NPI | 1295747384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 302717) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY F302717) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2011-08-26 |