| NPI | 1295966885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 336009) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 401484-1) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2010-07-21 |